Researchers have found that coronary artery bypass surgery may the best choice for diabetics and older patients with heart disease.
Coronary artery bypass surgery was compared against the less invasive percutaneous coronary intervention (with balloon angioplasty or with bare-metal stents) by researchers led by Professor Mark Hlatky of Stanford University School of Medicine, USA.
They explain that the procedures have been compared before but their long-term effects are unclear. In the Lancet, they report on their recent analysis of ten randomised trials involving 7,812 patients.
Over approximately six years, roughly the same proportion of patients given bypass surgery and percutaneous coronary intervention died (15 per cent versus 16 per cent).
However, in patients with diabetes, mortality was about 30 per cent lower in the bypass surgery group than in the percutaneous coronary intervention group. Patient age also affected mortality risk – those aged 55 to 64 years were 18 per cent less likely to die after bypass surgery than after percutaneous coronary intervention.
The experts feel that as long-term mortality is similar after both methods in most patient groups, “choice of treatment should depend on patient preferences for other outcomes”.
“Bypass surgery might be a better option for patients with diabetes and patients aged 65 years or older because we found mortality to be lower in these subgroups,” they conclude.
In a commentary, Professor David Taggart of Oxford University, UK, adds: “In patients with more severe coronary artery disease, and especially those with diabetes, bypass surgery is superior in terms of survival and freedom from reintervention.”
Hlatky, M. A. et al. Coronary artery bypass surgery compared with percutaneous coronary interventions for multivessel disease: a collaborative analysis of individual patient data from ten randomised trials. The Lancet, published online March 20, 2009.
Taggart, D. P. PCI or CABG in coronary artery disease? The Lancet, published online March 20, 2009.
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